31st Dr. Sun Yat Sen Oration

Mark Robert Miller

HK Pract 2022;44:21-25

Dr. Libby LEE, Director (Strategy and Planning), Hospital Authority, Prof the honourable Sophie CHAN, Secretary for Food & Health, Food and Health Bureau, Hong Kong Special Administrative Region, Dr. Donald LI, President, World Organization of Family Doctors, Prof. Joseph W. Y LAU, Chairman, Medical Council of Hong Kong, Prof. Gilberto LEUNG, President, Hong Kong Academy of Medicine, Dr. David CHAO, President, The Hong Kong College of Family Physicians and other senior College members. Distinguished representatives of the University of Hong Kong and Chinese University of Hong Kong, and the Presidents and Senior Representatives of the other Specialist Colleges and Academy Members.

To the graduates and new Fellows, and families, mentors and friends I bid you all congratulations and welcome.

I would like to thank the Hong Kong College of Family Physicians for inviting me to attend this ceremony and deliver the oration. In these difficult times attendance by Zoom has almost become an alternate reality for most of us both in our personal and professional lives.

With this modality in mind I have chosen to include visual metaphors and memes given the blended modality for delivery due to the current inability to meet in person. Hopefully time will free us from our current constraints along with judicious vaccination and adaptation. Where considered relevant I have added a brief bracketed description of the image being used at the time of the oration.

I would like to commence by acknowledging the traditional custodians of the lands from where each of us is attending tonight and pay my respects to their Elders past, present and emerging.

Dr. Sun Yat-sen; (12 November 1866 – 12 March 1925 was a Chinese statesman, physician, and political philosopher. He is called the "Forerunner of the Revolution" in the People's Republic of China for his instrumental role in the overthrow of the Qing dynasty and the "Father of the Nation" in other parts. (Image of cloaked traveler with guiding light and image of Sun Yat Sen)

I chose the title for this oration as the “Golden Journey” for several reasons, partly because of Sun Yat-Sen’s extensive travels across the globe starting with his birth in Zhongshan and then moving to Hawaii for early schooling overseen by his older brother then return to Hong Kong to complete schooling in topics on History , Science and mathematics and then commencing the study of medicine transferring to the Hong Kong College of Medicine for Chinese, the forerunner of The University of Hong Kong. Ultimately, he earned the license to practice as a medical doctor from there in 1892. Notably, of his class of 12 students, Sun was one of the only two who graduated. His journey may have ended there with a long and successful career in medicine however he chose a longer journey to many parts of the world seeking to undertake a broader role in society. (Image of hand holding up three fingers signifying the three principles of the people, Mínzú (民族主義), Mínquán (民權主義) and Mínshēng (民生主義)).

I will also consider the golden journey of our new graduates and fellows and also the challenging journey we are perhaps all currently upon to protect and enhance the quality of the world on which we all live. None of us live in a vacuum and our journeys are defined only by the interactions and interpretations of others as we move forward through life.

Often we forget the link between the past and the future. We often hear talk about “radical change“, “wiping the slate clean”, “starting over” and “greenfield sites” but we should acknowledge that evolution is this universes most powerful force for sustainable change.

As an example, why would someone choose a butterfly tattoo or a street artist choose to paint an image of one and why would Doctor Strange be reaching out to touch one? (image from Marvel film “Dr Strange”) Why has Martin Whatson created street art of a spaceman holding a butterfly in his work “Reflection” and why did Damien HIrst, whether you like his art or not, choose to create Mandela using butterflies? What has the Matrix to do with this story? (Image of Morpheus from movie “The Matrix” offering a red pill /blue pill). To understand this we need to track backwards and see where the origins of this journey lie.

In fact we need to track back to the 4th Century BC to the Chinese philosopher Zhuang Zhou. (image of Zhuang Zhou sitting eyes closed with butterfly) 昔者 莊周夢為蝴蝶，栩栩然蝴蝶也，自喻適志與，不知 周也。俄然覺，則戚戚然周也。不知周之夢為蝴蝶 與，蝴蝶之夢為周與？周與蝴蝶則必有分矣。此之 謂物化。

“Once upon a time, I, Chuang Chou, dreamt I was a butterfly, fluttering hither and thither, to all intents and purposes a butterfly. I was conscious only of my happiness as a butterfly, unaware that I was Chou. Soon I awaked, and there I was, veritably myself again. Now I do not know whether I was then a man dreaming I was a butterfly, or whether I am now a butterfly, dreaming I am a man. Between a man and a butterfly there is necessarily a distinction. The transition is called the transformation of material things.”

The existential nature of this original text is why it has been so incorporated into modern lore.

Perhaps orations help us remember that the past is the only light with which to truly illuminate the future.

So allow me to address our new fellows and graduates what of your own Journey/transformation? Perhaps your first day in Clinical General Practice was like an anxious leap into the abyss. (Image of man with hidden parachute leaping arms outstretched into “Cave of the Swallows” Mexico) However with supervision, mentoring, support, encouragement and the right equipment one can actually begin to enjoy the thrill of General Practice /Family Medicine and the leap into the unknown that comes with each new consult and challenge. (Image of others in appropriate gear base jumping into “Cave of the Swallows”)

Having become confident in day to day practice your thoughts begin to turn towards the exam and your first realisation of just how vast the curriculum of general practice and family medicine is as the first point of contact for the human condition. (Image of a toddler opening a book throwing it down and lying down and crying)

So you embark on learning as many facts as you can like learning the digits of PI but then hopefully sooner rather than later realising that the facts need to be applied you begin to hone your critical thinking skills. This is like learning mathematical formulae that contain PI until such is your mastery of the curriculum that even the most complicated issues become mere trifles to solve. But your accomplishment is greater than this.

Mathematics has the luxury of constancy, a^2+b^2=C^2 has remained unchanged from about a trillionth of a second after the big bang as did the fact that the circumference of a circle is equal to PI*r*2 and its area PI*r^2. They are not open to modification or interpretation. Einstein’s field equation holds true not just for this universe but possibly all universes once an appropriate coordinate system and cosmological constant is chosen. (image of Einstein’s Field Equation)

Not so medical knowledge. Things we once thought to be fact and standard management no longer are. A discussion with members of this audience would yield many things we were taught that no longer hold true in the field of general practice, family medicine and all the other medical disciplines represented here.

Having assimilated all the facts and critical performance skills you are ready to begin, I understand that cats may also use this method of learning. After obtaining your fellowship you begin consulting using all of your newly certified skills and yet patients still fail to follow advice or sometimes get better. (image of a cat getting ready to jump onto a roof with overlying complex mathematical formula before its failed leap)

I have watched this cat jump so many times and yet it has not once succeeded because it does not understand the complex condition we call human nature. (Image of two people sitting at desks, one labelled “Unpleasant Truths” the other desk labelled “Comforting Lies” only the “Comforting Lies” desk has a large queue of people waiting). Something we are dealing with as the result of the current pandemic and vaccine hesitancy. It has much do to with the flawed heuristics of human thinking when it comes to assessing risk at the extremes but that is beyond the scope of this oration.

We worry about failure but remember though that it is OK to fail, we cannot evolve if we do not sometimes fail. “The master has failed more times than the novice has yet attempted.”

These tag/word cloud images are produced by indexing common word occurrences within a document and serve to show at a granular level what concepts that within a subject occur most frequently and are considered important. A tag cloud will change and evolve as treatment and protocols change, such as the Australian guidelines for management of prostatic cancer, or this, which is a tag cloud of sentences with diseases starting with A from Murtagh.

However this tag cloud and this one I think help to distil the essence of general practice that just might withstand the test of time without significant change. They are if you don’t recognise them the Curriculum for general practice and the Competency Profile taken from the RACGP current documents. They define how we engage with communities in which we practice and their expectations of quality care.

So having completed your journey to fellowship when a patient provides you with the following list at a consultation, (image of scrap of paper from patient with a list that says, scabs on head, Rib Cage, Viagra and Nuts) you can sit back in your chair relaxed and know that today is going to be a good day. It is possible to forge a fine career one patient and one consult at a time, but it is possible to also have a broader role.

Looking around those assembled to night demonstrates this many times over. I am always impressed when I have attended the Hong Kong Academy of Medicine in the past that teaching and learning is valued so highly that so many senior representatives of the Academy choose to attend these ceremonies.

To the new graduates and fellows just as this journey is being celebrated tonight your next journey awaits. I would remind you that there is ample opportunity to involve yourself in the landscape outside of the consulting room as college members, through exam panels, expert committees, faculty board and recent fellows committees and in any role that adds and strengthens general practice and family medicine both locally and at a global level as I am sure Dr. Donald LI would encourage. You are spoiled for choice. If recent forays into space by many nations continue it will not be long before we are going to need some good family physician yŭhángyuán 宇航員or taikonauts.

Remember your role in strengthening general practice / family medicine is also not just about your training, it must be strengthened at all levels and our communities need to embrace their general practitioners / family physicians as a competent, trusted, efficient and safe entry guide into the medical system. I commend the Hong Kong College on their public awareness campaigns in relation to helping their communities understand the importance of social distancing and mask wearing. Even though they were all wearing masks it was great to see many of the senior members in your College stepping forward as part of their broader role. Just recalling the lovely Bach music backing to that media campaign reminded me of a piece of advice I would give when learning something new and that is we often practice until we get something right. In actual fact as I am sure most musicians in this audience would agree, that is only part of the journey and we should continue practicing our art until we can rarely get things wrong.

So what of the Journey we are all taking together? The significance of a comet gracing our skies would not be lost on those viewing this presentation. Their association with world changing events and harbingers of doom is well documented in time and superstition.

This is an image of comet C/2020 F3 better known as comet NEOWISE. Those living in the northern hemisphere may have been able to catch a naked eye glimpse of this comet in the night skies. Neowise will not return to our inner solar system and visibility for about another 6800 years. On historical records that would seem time for at least another 68 pandemics to threaten our world. “It is a poor sort of memory that only works backwards” says the White Queen to Alice, this quote from Alice in Wonderland by Lewis Carroll is a timely reminder of how important it is that the memory of this Covid pandemic its failures and success in management are carried forward in our memories not only for our generation but those who come after.

The problem when events such as this pandemic occur just at or beyond the limits of a human lifespan is there can be significant loss of knowledge and the detail may become obscured.

As an example this image may be familiar to some, others may know the name of this individual. Of course this is Florence Nightingale, an English social reformer, statistician and the founder of modern nursing. She is often described as the “Lady with the lamp” from her work during the Crimean war tending to injured soldiers. Often depicted in modern times with this sort of lamp (image of Middle Eastern lamp) in actual fact she carried this lantern which I understand is called a Fanoos.

So which memories would we like to see taken forward about Covid-19 to the next generation that will have to deal with another viral pandemic at some time in the future?

The details are critical.

• Early sharing of experience / research
• Appropriate declarations
• Consistent Leadership
• Handwashing and social distancing
• Early and frequent testing
• Early contact tracing and communication with the public regarding quarantine.
• Decreasing travel at global / regional / hot spots
• Utilising health service at all levels
• Family Medicine and General Practice help communities cope in times of crisis
• Watch for unintended consequences – mental health issues, decreased rates of diagnosis of other diseases.
• Economic considerations.
• Not all predictions will come true……

I used to think of our world as being vast and its populations relatively isolated from each other by distance. In this current age our ability and opportunity to travel has been greatly enhanced by technology and economics. The result for me is a changing perspective that our planet is really quite small and vulnerable in many different ways. Environmental issues affect us all regardless of where we live on this planet and the current pandemic shows that we are all vulnerable and cannot wholly exist in isolation as the rapid spread of this pandemic has shown.

This connectedness though also brings with it enhanced opportunities to network, pool research and discuss shared solutions. (Image of street art by Sam3, a small figure gazes up through a telescope. The night sky with crescent moon as an eye looks like a giant head in profile looking back down the telescope to scrutinise the small figure.)

Like this piece of street art by SAM3 illustrates sometimes as GP’s and Family Medicine Specialists we must finely scrutinise our patients at a micro level but as this pandemic has also demonstrated so often we need to be the ones gazing up and outward to solve broader based community issues such as access, mental health, population based screening and ongoing disease management beyond the virus itself. For others in even more senior roles they probably need to step back outside this image completely to gain an even broader perspective of societal impacts. Sharing our experiences through opportunities such as this online conference is important to us all.

Sometimes though our message and advice does not quite get through and this can be frustrating but each person has their own bias, opinions and agendas. (Image of chalk board with writing “A wise doctor once wrote” followed by several lines of illegible writing.)

This image shows Mars in close conjunction to the Pleiades Star cluster. Mars is some 22 light minutes away the star cluster around 444 light years. I am aware that the Chinese space program launched a probe to Mars TianWen1 last year and this arrived successfully now in orbit around Mars. Expertise from Hong Kong was instrumental in producing special camera equipment that helped the Zhurong rover choose its landing site and confirm preparation for its duties.

So 2020 was quite a dark year for our profession and we have had to gaze deeply into something that we have had very little experience with, but “you can never see further than in the dark” (Jon Fosse) and many advances have been made but our journey back into the light will still take some time.

Perhaps together we can find the best solutions to a complex problem?

As we draw to a close of this oration could I ask those in the audience to look at the following slide and put up your hand as to what level you feel you have reached in your career to date as I read them?

Novice, Apprentice, Journeyman, Expert, Artisan.

Being pre-recorded I will anticipate that most of us still rate ourselves as journeyman because we are truly all still on a journey.

To the journey yet to come.

Thank you for listening.